VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Programs

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form VA form 10-0491 VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Pr	Form	New	Repair queued
Justification AO34.docx	Supporting Statement A	Uploaded 2013-03-07	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
204870	VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Pr	Form	New

ICR Details

OMB Control No: 2900-0793	ICR Reference No: 201211-2900-008
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: VA	Agency Tracking No:
Title: VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Programs
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Comment filed on proposed rule	Conclusion Date: 04/30/2013
	Date Received in OIRA: 03/07/2013
Terms of Clearance: The information collection requirements associated with this proposed rule are not approved at this time. VA should consider any comments received and resubmit the ICR at the final rule stage.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: A collection of information is necessary to implement the Department of Veterans Affairs Visual Impairment and Orientation and Mobility Professionals Scholarship Program and the VA Health Professional Scholarship Program authorized under Public Law 111-163. This legislation allows VA to provide services to the public by awarding scholarships to non-VA employees who will be required to become VA employees in the professions for which they were educated under these programs. These programs will help address VA health care workforce needs.

---

Authorizing Statute(s): PL: Pub.L. 111 - 163 302 Name of Law: Caregivers and Veterans Omnibus Health Services act of 2010
   US Code: 38 USC Part 1, Chapter 5, Section 527 Name of Law: Measurement and Evaluation of DVA Programs
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
2900-AO34	Proposed rulemaking	38 FR 17	12/26/2012

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	38 FR 17	12/06/2012
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Pr	VA form 10-0491, VA Form 10-0491a, VA Form 10-0491c, VA Form 10-0491d, VA Form 10-0491e, VA Form 10-0491f, VA Form 10-0491g, VA Form 10-0491h, VA Form 10-0491i, VA Form 10-0491j, VA Form 10-0491k, VA Form 10-0491L	HPSP/VIOMPSP Academic Verification ,   HPSP/VIOMPSP Addendum to Application ,   HPSP/VIOMPSP Annual VA employment deferment Verification ,   HPSP/VIOMPSP Education Program Completion Notice_Service Obligation Placement ,   HPSP/VIOMPSP Evaluation Recommendation Form ,   HPSP Agreement ,   HPSP/VIOMPSP Application ,   HPSP/VIOMPSP Notice of Approaching Graduation ,   HPSP/VIOMPSP Notice of Change and/or Annual Academic Status Report ,   HPSP/VIOMPSP Request for Deferment for Advanced Education ,   HPSP/VIOMPSP VA Scholarship Offer Response ,   VIOMPSP Agreement

---

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new collection request. All burden hours are considered an increase.

---

Annual Cost to Federal Government: $4,911,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 03/07/2013

---